Melbourne School of Population and Global Health - Theses
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ItemImproving the Quality of Maternal and Newborn Care in East New Britain, Papua New Guinea( 2022)Quality care improves maternal and newborn health outcomes. Quality maternal and newborn care refers to the provision of evidence-based and respectful care to women and newborns by experienced and competent healthcare providers in a well-equipped and supportive environment. There is a need to prioritise improving the quality of maternal and newborn care globally, especially in low- and middle-income countries, such as Papua New Guinea, where women and newborns experience high rates of morbidity and mortality during pregnancy, childbirth and the postpartum period. Papua New Guinea is a country situated in the South Pacific region, with a population of around nine million. East New Britain is a rural province in the Islands region of Papua New Guinea, with a population of approximately 400,000. Most Papua New Guineans live in rural and remote areas like East New Britain, making healthcare access geographically challenging. Geographical access issues can be further compounded by financial and cultural factors, as well as health system limitations such as health workforce shortages, inadequate health service infrastructure and a lack of essential medicines and supplies. Implementing interventions to improve the quality of maternal and newborn care in Papua New Guinea must be preceded by a systematic and comprehensive assessment of the quality of maternal and newborn care provided and experienced. This PhD study aimed to fill this knowledge gap and examined the provision and experience of quality maternal and newborn care in five health facilities in East New Britain using a three-phased participatory methodology called partnership-defined quality. This PhD study was part of the Gutpela Helt Sevis, Helti Mama Bel, Helti Beibi Stadi (Quality of Pregnancy, Childbirth and Newborn Health Services Study), and sits within the Healthy Mothers, Healthy Babies research program. The Healthy Mothers, Healthy Babies program was established in 2015, and is led by Burnet Institute in partnership with the East New Britain Provincial Health Authority, Papua New Guinea Institute for Medical Research, University of Papua New Guinea and the Kirby Institute, University of New South Wales. A multiple methods design and a partnership-defined quality approach were used. Firstly, a scoping review of the evidence on interventions to improve the quality of maternal and newborn care in low and middle-income Pacific island countries was undertaken to inform the design of the quality improvement study. This review found that many initiatives to improve quality care were being implemented in the Pacific, including in Papua New Guinea. Most initiatives focused on the clinical service level, with very few addressing system-wide improvements or patient experiences of care. Enablers to quality improvement initiatives included community engagement, collaborative partnerships, staff education and training and alignment with local priorities. Barriers included little to no involvement with provincial and national health departments, restrictive donor-defined objectives, contractual obligations and funding delays. The review was followed by a focused study using quantitative and qualitative data collection techniques in East New Britain to: i) describe community members’ perspectives and experiences of quality care during childbirth and the immediate postnatal period; ii) examine the perspectives and experiences of women, their partners and health providers regarding labour and birth companionship; iii) appraise early newborn care practices and identify opportunities for improvement; and iv) to identify feasible and effective strategies to optimise the quality of maternal and newborn care in participating facilities. The findings from the quality improvement study are presented in three key areas – what the community thought about the quality of care provided; issues around labour and birth, such as companionship; and care of the newborn, including early newborn care practices. Community members emphasised the importance of effective communication and competent and respectful health providers. Women and partners wanted companions present during labour and birth, whilst health providers had mixed views. Only 30% of women had a companion present during labour, and 10% at birth. Most newborns received at least one essential newborn care practice in the first hour of life, such as immediate and thorough drying (97%). Multiple barriers to quality care were identified, including an insufficient workforce, critical infrastructure and utility constraints, and poor availability of medicines and equipment. This thesis demonstrates gaps in both the provision and experience of maternal and newborn care in East New Britain. This thesis highlights that a sufficient and well-supported health workforce within an enabling environment is vital to achieving quality maternal and newborn care. Policies that promote and support quality care are needed at all levels of the health system in East New Britain, and quality improvement needs to be embedded into routine practice. Gaps in the quality of maternal and newborn care can be filled by local quality improvement initiatives, such as supporting women to have a companion of choice present during labour and birth. Lastly, community engagement and leadership are essential for effective quality improvement interventions to improve maternal and newborn health.